(This is the seventh part of a fictional short story - In you we trust. You can find the first part here.)

Hepatitis C is a scourge in dialysis units today. Many patients become Hepatitis C positive a few years into dialysis. The indolent nature of the disease has caused not enough attention to be given to it. Medical proessionals are more focussed on immediate problems that dialysis patients face. A disease that takes about a decade to start showing clinical symptoms is not very high on the priority list of nephrologists.

Left untreated, the disease can cause Liver Cirrhosis, Liver Cancer and Liver Failure in about twenty years in non-dialysis patients. In dialysis patients this period is about ten years. Still, ten years is a long time for a dialysis patient.

Many dialysis patients do not even know about the danger of getting cross-infected with Hepatitis C in their dialysis units. It hits them only when they turn positive. Like other chronic conditions, this is also something that 'cannot happen to me'!

Despite all her knowledge about kidney disease Aparna was ignorant about Hepatitis C. All she knew was 'positive patients' had to dialyze in a separate area. She hadn't bothered to find out more about the disease. 'It cannot happen to me', was what she thought too.

One morning, as Prakash started Aparna's session, Aparna noticed him drawing a blood sample for an investigation. She had not asked for any test. Why was he drawing a sample, then? He asked Prakash. Prakash said he was dawing a sample for Hepatitis C testing. Aparna asked him why he was doing that when they had sent the sample in the first week of the month as usual and it was already negative.

Prakash was fumbling as he answered. He said something about some mistake being committed in the Reprocessing Unit, about some mix up happening, about her dialzyer being mistakenly reprocessed in the positive reprocessing machine.

Aparna was apalled. Though she did not know exactly what had happened, it sounded horrible. She had a very disturbed session that day. She started imagining all kinds of horrible things happening to her. The word 'positive' has a very negative connotation. Though people on dialysis who are Hepatitis C positive will very likely not be affected by the disease, a whole lot of other issues crop in.

Aparna got on to the internet and read up all she could about Hepatitis C in dialysis patients. The fact that there wouldn't be any symptoms for years offered no consolation. She had plans of living for long on dialysis and this could mess things up a lot. She started doubting Prakash's role in this. The guy probably hates me. He might have done this just to get back at me. But then she thought that may not be true. No one can fall to that level. Not even Prakash. He has an ego but he will not stoop to a level where he would play with someone's health.

The report came back negative. Aparna was relieved. However it was not all over yet. The Hepatitis C virus can be in a so-called incubation period for months. Every month, Aparna would have to undergo the test to make sure she has not turned positive. At least for another 4-6 months.

Aparna was quite disturbed with the recent turn of events. At the back of her mind she had this nagging doubt that this was done on purpose by Prakash. She wasn't convinced however. She thought no one could do such a thing. She was wondering if she should talk to Dr. Jha about this. She debated this for a while. Maybe Dr. Jha could do something about the virus in the incubation period if it was already there? Maybe some additional tests might help check on this? She decided to talk to him eventually.

Dr. Jha appeared quite unfazed when she talked to him. He offered rather blandly, "Aparna, let us not assume anything until we get a positive result."

Aparna got a little worked up.

"But Doctor, what if I have really been infected? What if the virus is in the incubation period?"

"I would strongly advise you not to stress yourself too much with this. Let us repeat the test every month and see."

Aparna was disappointed. Dr. Jha hadn't been very helpful.

That evening, while watching TV at home, her brother called her. For the first time in many months, she broke down. Her brother felt helpless. He wanted to help her but could do nothing. He was stuck in a job in the US and couldn't return to India for another year. After the call as well, she put her head in her pillow and cried bitterly for about an hour. She felt very lonely and desperately wanted some support. She felt it was totally unfair for her to deal with all this all by herself. All her friends had got married and had loving and caring husbands. Some even had kids. And here she was, all alone in this world having to deal with this disease. She had come to terms with the dialysis bit. But this whole new Hepatitis C angle to it left her very scared.

(This is the sixth part of a fictional short story - In you we trust. You can find the first part here.)

Aparna used to read up a lot about her condition. She also read up a lot about dialysis. She was a member of an online forum of dialysis patients too where she would get a lot of information about the dialysis process and the various factors involved in it. Over the months she had developed a very good understanding of the concepts involved. She was completely on top of her dialysis settings and would insist that she dictate the parameters rather than the technicians.

Prakash, on the other hand, got all his dialysis knowledge from practice. For the past so many years, he had encountered many situations which helped him to handle most complications fairly well. However, his theoretical background was weak. The diploma he had done was like most other diplomas in the city. Theory was rarely taught. The students were simply expected to come to the unit and then learn the practical aspects of dialysis from the seniors. They did what the seniors did. If some senior learnt something the wrong way many generations back, chances are that several generations of dialysis technicians down the line were repeating the same mistake.

For the past few weeks, Aparna noticed something peculiar about an elderly male patient who used to generally be taken in the bed opposite to her on the same days as her, in the same shift as her. He would come in with barely a liter of extra fluid but about halfway into the session, he would get severe cramps. The technicians were simply not able to pull off even that minimal amount of fluid. This baffled even Prakash. Aparna had an idea. But she was wondering how she could tell Prakash.

Aparna knew exactly how Prakash would react. He was the kind of guy who would feel so belittled if someone else gave him an idea in his field of expertise that actually worked. It would be much worse if that someone was a patient. And even worse if Aparna gave that idea. Aparna realized this. But she couldn't let the patient suffer any more!

"Increase the conductivity!" she shouted out as Prakash was discussing the problem with the junior technicians while starting the man's session.

Everyone turned to look at her. Prakash's face turned red. The juniors turned to look at Prakash. The patient looked at Aparna and then at Prakash. Aparna regretted it instantly. What have I done?

Prakash burst out laughing. He shook his head in disbelief. There was silence all around. He did increase the conductivity however. He increased the Prescribed Sodium setting. The conductivity came up to about 14.5 in a few minutes. Prakash kept returning to the patient to check if he was cramping. He was doing quite well. The fluid was all successfully removed. For the first time. Aparna was also keeping an eye on the patient. She was happy to see that the fluid was removed as well. She knew what keeping extra fluid on meant. Prakash did not talk to Aparna that day. He closed her session. But did not say a word.

Prakash went home that night very dejected. Why didn't I think of that? There was nothing great in what she suggested. It was not a new medical discovery. It was the obvious solution. But still, why didn't I think of that? She is not even qualified in dialysis. She has no experience. She is only a patient. How did she think of that and why didn't I?

He recollected all the nice things patients said about him. They treated him like God. They brought gifts for him. He thought about all the times he thought of innovative solutions to the issues patients were having on dialysis and how he had relieved them of their problems. He kept picturing himself cannulating different patients. He remembered patients allowing only him to cannulate. It felt good. It felt good to have so many people look up to you. It felt good to have so many people revere you.

And then there was this patient. What did she think of herself? Who did she think she was? Telling me what to do! Look at her guts. The way she shouted out in front of everyone. She wanted to insult me. That was her only intention. She had no interest in the patient. All she wanted to do was to insult me. The bitch! She must be taught a lesson. A lesson she would never forget.

(This is the fifth part of a fictional short story - In you we trust. You can find the first part here.)

"I can't believe no one told you yet!", said Aparna. Dr. Jha's face was very serious. Aparna came to meet him before her session. It was a week since the incident had happened. Nothing was done about it. She came to Dr. Jha to check what he was going to do about the incident. No, not the alarm. Alarms happen all the time. Even air detector alarms. But a senior technician slapping a junior technician. That couldn't be allowed!

Dr. Jha asked when this had happened. "Exactly a week back. Last Friday. In the evening shift.", Aparna replied. Dr. Jha immediately understood. Of course no one would complain. Who would? The junior techs? The patients? Who would take on the mighty technician and risk his wrath?

"Ok Doctor." Aparna got up to go to the unit and get started. As she was leaving the OP room, Prakash was entering. They avoided eye contact. The last two sessions had been similar. No eye contact. Prakash would avoid all conversation. Aparna also did not say a word. Nothing much changed inside the unit. The junior was back the very next day. Everything seemed normal.

Aparna wondered why no one had complained to the Doctor. Well, patients would definitely not complain. For one, they had nothing to do with it. And then, who wanted to upset the lead technician? But what about the staff? The staff were probably too scared to complain against their senior. He had all the power in the unit. Dr. Jha fully trusted him. The patients loved him. So, was nothing going to be done about this? Perhaps. Unless Dr. Jha puts his foot down.

Prakash entered the unit after about five minutes. He went and sat at the nursing station. Aparna was waiting for him to come and start the session. He got busy on the inventory register. After a couple of minutes, he called out to the junior tech who had assisted him last Friday. He whispered something in his ear. The junior looked surprised. He came over to Aparna's bed and said he was going to start the session as Prakash sir was busy. Aparna's heart became leaden. So this was what happened if you complained!

Luckily the session started without any problems and the cannulation wasn't bad either. But Aparna felt her eyes become heavy once the session was on and the tech had also moved away. She fought off her tears.

After a while Dr. Jha came on his rounds of the unit. Prakash accompanied him as he moved from bed to bed. When he came to Aparna's bed, there was no discussion about the incident or the complaint. After the session, Aparna went to his OP room but he had left. She was about to dial his cell phone on her way to the car. But she disconnected when she realized it was 9 in the night. What had the Doctor told Prakash?

She couldn't sleep until late that night. She kept thinking about the last one week. She was wondering if she had done anything wrong. Now that she had complained against Prakash, would he never cannulate her? Would she always be cannulated by the junior techs? What if she ran into complications during the session that couldn't be handled by the juniors? What if Prakash refused to help? Should she change her unit? The others were too far away.

Aparna called Dr. Jha next morning and asked him what he had told Prakash. Dr. Jha said he had sorted the matter. Prakash would control his temper and not slap anyone in the unit. "That's it? No punishment?", she asked.

"Aparna, this is not a school where we can punish students. I counseled him on how to behave with junior staff. After all he is very good at his work. A few rough edges for sure. But nothing that can't be corrected. How are you feeling?"

"Fine doctor. Thank you. Ok bye doctor." Aparna said as she hung up.

On the next session on Monday, Aparna dreaded what was going to happen as she walked towards the dialysis unit. When she went in Prakash was cannulating another patient. She checked her weight as usual and went over to her regular bed. After a few minutes Prakash came over to her and started the process of beginning dialysis. Aparna felt a little relieved. They did not speak anything. But at least he was starting her session.

The next session when she entered the unit Prakash greeted her and asked her how she felt. She smiled back and responded. Within a few more more sessions, both were normal. The past was forgotten, Aparna felt. In her own interest, she must be on good terms with Prakash. Let's face it, I need him more than he needs me.

(This is the third part of a fictional short story - In you we trust. You can find the first part here.)

Within a few weeks, everyone got to know that Prakash was very skilled. He could cannulate difficult cases with ease. He knew the machines inside out. He could handle complications also fairly well. He gained everyone's confidence.

Prakash took pride in his work. He was extremely confident about his abilities. Education-wise Prakash was like many other dialysis technicians - no graduation degree, only a diploma in Dialysis Technology. Yet, he was very skilled. Patients wanted only him to cannulate. They hardly felt any pain. He could cannulate in one attempt.

Cannulation is a tricky beast. Some people say it is a natural gift. Some people say it can be mastered by practice. Some people accuse it of being over-rated. Whatever it is, one thing is for sure - cannulation is the thing most dialysis patients fear like hell. Severe pain is one of the less damaging effects of a badly done cannulation. Worse things can also happen.

Prakash slowly took over the administration of the unit as well from Dr. Jha. He adroitly handled staff scheduling, patient scheduling, inventory, housekeeping - everything that needed to be done in the unit. The junior staff did not mind this at all. They recognized their limitations and were also happy that the burden of all these things was no longer on them.

Dr. Jha was a happy man! He could now focus on things he really needed to focus on, things he was meant to focus on.

One Friday evening, Aparna came in for her session. Of late, Aparna had also been impressed by Prakash's handling of the unit. She found that she got onto the session much sooner than before, could leave once her session was completed much sooner and overall the unit looked much cleaner and more organized than before.

It wasn't like this always though. She was coming to Charaka only because she stayed close by. She would not generally tolerate inefficiencies easily. But she had little choice given the distance other units were from her house. But now, things looked better. She was hoping Charaka would offer good quality dialysis now that they had a good technician in place.

Aparna got on to her bed and waited as the junior tech primed the dialyzer and the bloodlines. She had checked her weight herself and was calculating the weight gain. 3.5 kgs! Hmmmm, however much I restrict my fluid, I do not put on less than 3 kgs! What is the point in restricting?

Prakash came and wished her.

"How are you Aparna madam?"

"Fine, thank you, Prakash"

"How much weight gain today?"

"3.5 kgs"

"Hmmm, too much water?"

"No Prakash. I hardly drink any water."

"That's what all patients say madam! I wonder how the weight goes up so much then!"

Prakash laughed as he said that.

Aparna hated to be compared with 'all patients'. She was not one among 'all patients'. She knew her body and no one else did. She did not drink that much. She knew it. Who is this technician telling me all this bullshit?

She refrained from reacting however.

Prakash got ready to start the session. The junior tech who primed the line was assisting. Cannulation went on smoothly. Prakash connected the bloodlines and started dialysis. Within a minute or so, the Air Bubble Detector Alarm rang. Beep, beep, beep! Prakash reset the alarm. Very often these alarms are only transient alarms. A mere reset a few times does the trick.

Not this time. Beep, beep, beep!It went on.

Prakash noticed the venous chamber had become frothy. There was excess air in the system.

Beep, beep, beep,the noise continued.

Aparna was worried by now. Most alarms were always taken care of by resetting. What was this,Aparna wondered. She asked Prakash which alarm this was. Prakash ignored her. She persisted.

"One minute, madam."

Aparna waited.

Beep, beep, beep,the alarm nauseatingly continued.

Aparna asked the junior which alarm it was.

"Air detector, madam", the junior offered. He knew there was no point in hiding anything from this patient.

Aparna also got really worried now. This was the most dangerous alarm among all the alarms that could go off in a dialysis machine. Dialysis machines were designed to ensure that even a little amount of air did not enter the blood of a patient.There is an air bubble detector that is placed in the circuit just before the blood is returned to the patient. Any tiny droplet of air sets of an alarm and the blood is stopped. Only when the air is removed can the blood be returned.

Aparna kept a close watch on what Prakash was doing. She saw Prakash remove the line from the air detector. This would bypass the alarm without actually correcting the problem.

"Its not. The venous chamber is full of bubbles! Check the connections to the dialyzer and the dialyzer caps. They might be lose." Aparna said.

In an instant Prakash knew that she was right. That could be the only reason. He immediately reached for the dialyzer. One of the connections to the bloodlines was loose. Air was entering into the system through that. Prakash immediately tightened the connection, inverted the dialyzer and hit the dialyser with his palm nudging the air to the top so that it could all accumulate inside the venous chamber. Within about five minutes, the air bubble detector alarm stopped and dialysis began.

Prakash was livid. The junior had not tightened the connections. This was a part of the priming process! How could he have not done it? He quickly completed the other formalities and asked the junior who had primed the kit to come into the ante-room that was behind the nursing station. The junior's face paled. Within a few seconds of him entering the ante-room, a loud slap was heard. The junior came running out of the room, hand on cheek, tears rolling down his cheeks and left the unit. The patients were all shocked. Aparna couldn't believe her eyes. She did not know what to do or say.

Silence enveloped the entire unit the rest of the evening. Prakash was still angry. The staff were all visibly shaken. The patients hoped they would have no complications that evening. Aparna couldn't think of anything else. She replayed the sequence of events in her mind again and again. She wondered if she could have handled the situation in a different way. She was convincing herself that she did what was right for her. If she had allowed Prakash to remove the line from the air detector, her life could be at risk.

Prakash came to close her session at the end of four hours. They did not say a word to each other. Another junior lead Aparna out after checking her weight. As she settled into the seat of her car, she thought to herself, "What just happened?" She had no clue. It was all like a blur. Like it never happened. It was too weird to have really happened.

(This is the third part of a fictional short story - In you we trust. You can find the first part here.)

The month passed by quickly.

Prakash was there on the designated day at the dialysis unit at Charaka Hospital, all excited and ready to take charge. He went over to meet Dr. Jha first. Dr. Jha was getting ready to go on his rounds. Though Prakash would need to report at 7 a.m. every morning, on the first day he was asked to come at 9:30 so that he could be introduced to the rest of the staff. This was going to be a little tricky. Whenever someone from outside comes and joins a team in a superior position, there is always a risk of the existing members of the team feeling insecure, threatened and even being non-cooperative with the new leader.

Dr. Jha was aware of this. He first sat with Prakash and explained this to him. He counseled him on how to deal with each member of the staff, their strengths and weaknesses and how to slowly win each one's confidence. Dr. Jha mentally grinned and patted himself on the back. In a short span of time, he knew more about the dialysis unit staff than he had ever known about any of his direct reports!

The doctor led his hopefully-soon-to-be-trusted lieutenant to the unit and gestured for everyone to come to the nursing station. The staff collected quickly. They all respected the doctor and knew he had concerns regarding the unit. They were all trying to impress him. However, they realized, it hadn't been enough.

In chaste Kannada, the doctor began, "Hello friends, I am happy to introduce Mr. Prakash, the new Chief Dialysis Manager of our dialysis unit." He had picked up the language in his decade or so in the state quite well. It is important for doctors to speak the language of the patients. They can relate better. More than half of his patients were Kannadigas.

Some dialysis patients woke up to see what the fuss was all about. Some slept back. Some strained their ears to catch what Dr. Jha was saying. Any distraction is good enough when you're on dialysis!

"Prakash has many years of experience in running dialysis units. Prior to this, he was working in Sanjivani Hospital as Chief Dialysis Manager. Prakash will now lead the operations of the center. I will be working very closely with him to make sure that the transition will be smooth."

A machine sounded an alarm. One of the junior techs rushed off to press the Mute button. The patient had moved his hand to cause a kink in the tubes. The tech straightened the line and reset the alarm. He rejoined the group. The meeting continued.

"I thank you all for the co-operation you have given me in the last few weeks and am sure you will co-operate with Prakash in the same manner. I wish Prakash and all of you the best of luck in your work at this hospital. Thank you."

There was a light applause.

Dr. Jha asked Prakash to get himself familiar with the unit. He would finish off his rounds and join him. He would start transitioning all the responsibilities one by one to Prakash. Dr. Jha rushed to the IP rooms where his cases were admitted. The IgA Nephropathy case was doing much better. He wasn't fully all right though. The new drug had the desired effect. It took more than two weeks for them to see his values return to normal. Those two weeks were very tense for the patient, his family and the doctor. There was a mild infection which they were treating now. That was also on the wane. Hopefully they would be able to discharge the patient in a few days.

Prakash started interacting with the technicians and nurses. He wanted to get a sense of how things were in the unit. He asked to be introduced to the patients. The junior techs took him around and started telling the patients who were on dialysis about Prakash. Some of them were asleep. Prakash signalled not to bother them. He knew that sleep was the best way someone could spend a session on dialysis. They came over to a bed where there was a pretty, young girl. She was awake reading a book. The techs introduced her to Prakash as Aparna madam. "This is the new Dialysis Manager", said one of the techs, "Prakash sir".

"Oh good", said Aparna, "now your work will become easier", she smiled and said to the junior techs. They all smiled back.

Aparna was on dialysis for the past four and half years. She was diagnosed with chronic kidney failure about five years back at the age of 24. Anyone would have been devastated with this sequence of events but not Aparna. She quickly gathered herself and fought to regain control of her life. She started working part time within a year of being on dialysis and she was now working full time. She had lost both her parents at a young age and only had a brother who stayed in the US with his family. They visited India rarely but kept in touch with her every week on phone. She usually came for her session in the third shift but today she was taking the day off to attend a family function and wanted to be done with it in the morning.

The techs moved to the nursing station and told Prakash that Aparna madam was their most active patient. She knew a lot about dialysis and would correct the mistakes they made not only in her case but also in other cases. Prakash raised an eyebrow. Correct mistakes in other cases as well? Hmmmm...

(This is the second part of a fictional short story - In you we trust. You can find the first part here.)

"Good morning Anu!", Dr. Jha said as he entered his department. Anu had just got in and was surprised to see her boss come in so early. He looked quite excited. He quickly put his things in his room and dashed off towards the IP rooms on his daily rounds of the admitted patients. He had also found something to try for the troubling IgA Nephropathy case.

Dr. Jha hated for a transplant to fail. A transplant, he believed was the ultimate challenge in nephrology. It was the only real treatment, he felt. Dialysis - even daily - was at best a compromise. Yes, good, frequent, long duration dialysis did offer a good quality of life but it wasn't even close to the quality of life offered by a transplant. And then you had the whole act of donating an organ. This, he felt, was the ultimate donation anyone could ever make, the ultimate act of altruism. Dr. Jha would always have a one-on-one session with the donor before the transplant allaying any fears, giving strength and strongly praising the decision to donate. One of the main reasons he was very keen that every transplant succeeded, apart from the well-being of his patients, was that he did not want the donation to go in vain.

Dr. Jha made his way to the Transplant ICU where the IgA Nephropathy case was being kept. It was a young boy of about 28 years. Everything went well during the transplant. His mother had donated. The mother was fine, as expected. For about a month, everything was fine and then suddenly the creatinine started rising. Dr. Jha, the boy and his family, everyone was on tenterhooks. This wasn't a new occurrence for the doctor. He had handled rejections and worse in the past. Yet, with every case, there was this nervousness. The stakes, after all, were so high! For Dr. Jha, it was one of many transplants. For the patient however, this was his only shot at a normal life. His one chance. Dr. Jha realized this.

As he greeted the patient after donning the mandatory gown, mask, gloves and slippers, he said he was changing one of the drugs in his prescription and hopefully that should improve the kidney function. The patient understood. Transplants are a tricky business. You are never quite sure of what to do. The boy was aware of this and was happy to be in good hands. He trusted Dr. Jha completely.

By the time he completed his rounds of the other IP patients and returned to his room, it was around 11:30. He asked Anu for a cup of black tea and settled down at his table rummaging through the journals to read up a little more on one of the IP cases he had just seen.

"Sir, Prakash, dialysis technician, is here for an interview", Anu's voice announced on the phone.

"Send him in!"

In his preoccupation with the transplant case, Dr. Jha forgot to visit the dialysis unit and all about his problems with the understaffing. He looked up in anticipation as a short, lean and unassuming young guy, twenty five perhaps, asked to come in. Dr. Jha gestured him to come and sit just as his cell phone rang. Quickly muttering an apology to the caller, Dr. Jha focussed on the resume which the candidate gave him respectfully. It was the same resume that he had seen earlier. The same mistakes, the bad formatting, the wrong spellings. These things did not matter of course, as long as the guy knew his job well!

The interview lasted about 45 minutes. The doctor and technician took an instant liking for one another. Prakash knew dialysis. He was passionate about it. It was easy to see. Unlike many other technicians Dr. Jha had encountered in his career who had at best, a superficial understanding of dialysis, Prakash knew the concepts. About twenty minutes into the interview Dr. Jha had made up his mind to hire him. But he continued because it had been a long time since he had had an interesting discussion on the subject with someone of Prakash's background. More than anything, Prakash's enthusiasm intrigued the doctor. They discussed Kt/V, its merits and demerits, Peritoneal Dialysis, using high flux dialyzers, cross infections and much more. Towards the end, Prakash also felt the interview was going well and was quite confident of being hired.

Dr. Jha then broached the topic of the salary. Prakash's expectations were reasonable. He asked for about 25% more than what they were paying Ramesh and about 30% more than what he was being paid at his previous job. Prakash would serve his notice period of a month and then join Charaka.

"Welcome to Charaka!", Dr. Suketu Jha said as he offered a handshake to Prakash. Prakash beamed as he took the doctor's hand and excitedly said, "Thank you sir!"

"Welcome to Charaka!", Dr. Suketu Jha said as he offered a handshake to Prakash. Prakash beamed as he took the doctor's hand and excitedly said, "Thank you sir!"

Dr. Jha's search had ended. Ever since the senior most technician of the dialysis unit of Bangalore's swanky and famous Charaka Hospital, Ramesh, had resigned to join one of the new standalone dialysis chains coming up in the city, the operations of the dialysis unit had suffered. What could two junior technicians do, after all? The number of patients also kept growing as Dr. Jha was a skilled and empathetic doctor, a rarity these days. Months of newspaper ads, checking with contacts, even unabashedly calling techs himself, yielded little success.

Then finally, almost out of nowhere, Dr. Jha saw an email in his inbox one evening after his usual rounds. The subject read, "Applicn. for Sr. Dialysis Tech. - 8 yrs exp". Dr. Jha chuckled as he took in the abbreviations. But 8 years experience looked tempting. He went over the resume. It was a typical technician's resume. Bad formatting, spelling mistakes, a pompous objective. One thing struck him however. 8 years in only 2 jobs. That was rare in this industry! Dr. Jha called Anu, his secretary, and asked her to schedule an interview.

It was almost 8 in the evening when he could finally leave his room. On the way out, he stopped by at the dialysis unit as usual. Four cases were going on. The two junior technicians were managing the unit. There were two nurses helping out. But Dr. Jha was never sure. He dreaded every call from the unit fearing the worst. He checked with the staff if everything was ok. One patient's BP had dropped a bit. Dr. Jha advised that they reduce the ultrafiltration volume. One of the techs proudly said that they had already done that. Dr. Jha smiled and said, "Good!" Under his breath he muttered, "Wasn't it obvious?!" But he realized that he needed to handle these rookies with kid gloves.

As he made his way to the car park, Dr. Jha thought about how easily he had set up the unit about a year back. He had found a team of technicians who were available as a dialysis unit about six kilometers from where Charaka was located had closed down. Ramesh had been very good, very efficient and took complete responsibility leaving only the medical management to Dr. Jha. But when he was given an offer by the standalone chain that was being started at almost double the salary he was currently getting, Dr. Jha could do little to convince him to stay. He did not even make an effort to talk to the management of Charaka because he knew what they would say. Ever since Ramesh had left, his problems started. The junior fellows did not know even basic inventory management, patient scheduling and other book keeping. Dr. Jha had to spend a lot of time in the unit fixing things and guiding them.

"Let's hope this new guy is some good," he thought to himself as he got into his Honda City and headed home.

That evening as he opened his MacBook Pro to look for some information on uptodate.com about a particularly difficult post-transplant case where an IgA Nephropathy case had shown an increase in renal parameters, he saw an alert in his Google Reader page that was headlined, "The Lufkin Davita Bleach Murder Case: Opening Salvos". He opened the link and read with horror the accusations against a dialysis nurse in Texas state in the US of injecting bleach into some dialysis patients at a Davita dialysis center. Dr. Jha was appalled on reading the sequence of events. How could anyone do this? How could anyone betray the trust of a patient?There was some mention of a Davita conspiracy to implicate the nurse to cover up bad processes. Dr. Jha felt a shiver down his spine. What precautions do I have in place to prevent this kind of a thing from ever happening?

Was the nurse at fault? Was it the unit? Either scenario was scary. I should institute processes immediately to make sure the chlorine content of the RO water is checked every month. Why every month? Why not every week? This was a critical aspect of dialysis. In fact, I should have it done every day! What about the staff? How can I make sure that they do their job? One disgruntled staff member is enough to bring about disaster in our unit. Just one disgruntled staff member!

Dr. Jha then took a Restyl 0.25 mg. He needed some sleep. Everything would be ok, he reassured himself. Indians never feel so strongly about any thing.An Indian would never kill a patient.The Restyl began to act. An Indian would never kill a patient. An Indian would never kill a patient. The Restyl took over completely.

Last week Shirley (not her real name) wrote to me. She was worried about how her relationship with her boyfriend would change (or survive) now that he has kidney failure. I think Shirley’s email, and maybe my answers, will be relevant to many other members of the BigD club, not the least because they will realise that they are not alone.

Hi Greg,

My name is Shirley and I came across your blog through the Kidney Australia website. I’m sure you get plenty of e-mails, thank you for taking your time to read this!!

My boyfriend has kidney disease with a function of 50%. He is 32, eats healthy and is generally fit. Over the past few months he has become increasingly tired which is affecting what we do on a weekly basis. I’m 25 and have many things I want to do in life but am unsure if we’ll get to do these things.

I guess what I am asking is how did your experiences with kidney disease affect your relationship and the things you did/do with loved ones?

I am really struggling with everything that is going on as I want to marry my boyfriend but he feels that he is limiting my life experiences as we don’t go out much anymore, leave places early etc. I feel selfish if I want to go for a night out etc. so I usually make sure we’re doing movies and dinner or something where he can go home early to sleep.

I know it sounds silly about ‘a night out’ but I feel like this is the time I should be doing all this before life gets ‘serious’ and with my partners kidney disease all these decisions become ‘serious’ and it scares me!! I could just be young and naïve and might look back in 5 yrs and think bloody hell I was upset about going out? Lol but please understand that I’ve had a lot of growing up to do and have made a lot of changes to suit my boyfriend’s needs. It’s never bothered me but has come up in the past month and is impacting us dearly.

We want to turn around kidney disease ruling our relationship and determining our future. I had a few questions, whenever you have time please respond. Any advice or experiences would be much appreciated

What things did you do to ensure kidney disease did not stop you from your day to day things?

How did your day to day life change as you got older? Is there a big impact?

If you have a partner how did they cope with the kidney disease? What changes did you both have to make?

When did you have to get dialysis and how did this impact your day today life?

I’m sorry for all the questions and I’m sure I could just look it up on the net but I was desperate to contact someone who has experience and understanding with kidney disease. I am scared for my boyfriend, I love him very much and am scared how this will impact us emotionally, socially and financially. I know people would say if you loved him you would just stick by him and work through it but it’s not that easy and I feel immense pressure because I love him so dearly but don’t know how and if the kidney problems will impact our future a lot.

I really appreciate your time in reading this e-mail. Your blog is amazing and you are truly an inspiration.

Kind regards,

Shirley

Hi Shirley, thanks for your email. You are not alone. Many people feel as you do when kidney disease attacks their partner: How will this affect our lives? How will it affect my life?

Unfortunately, the answer to both those questions is quite a bit. Kidney disease is a game changer, sending your lives off into a new direction. Not necessarily a bad direction, just a new, usually unexpected one.

So, what can you expect?

It sounds like your boyfriend’s kidney function is slowly dropping. Eventually, it will fall below the level where he cannot live without kidney replacement therapy (usually dialysis). During this early stage, your social options will be restricted. He will become progressively weaker and more easily tired, have headaches and nausea; you’ll leave social events early, maybe a miss a few. He won’t be able to travel far from home/hospital. His doctor will prescribe progressively more food/protein restrictions and he will feel pretty miserable. He may be forced to move from full-time to part-time work, or work may become too difficult.

Eventually, he will go onto dialysis, typically three times a week for about four hours per time. The rest of the time is yours. A surprise for most people is that after a few weeks they begin to feel much healthier and have more energy. In fact, for much of the time outside dialysis sessions, life can come pretty close to what it was before kidney failure, especially when you are young. If you have a flexible employer part- or full-time work becomes possible. Travel takes a bit more organising, but is definitely an option.

If your boyfriend has a transplant, in most instances, he will stop dialysis and live a normal life. He will take anti-rejection drugs for the life of the new kidney, but with a healthy transplant, your life together can be all you want it to be, including travel, socialising, some sports, and full-time work. A word about transplants: think of them as another treatment for kidney disease, they are not a cure, and like all large operations, some fail and can give you a very difficult ride.

A key element while on dialysis and with a transplant is to keep fit. Getting back to the gym as quickly as possible once things settle down helps you get back to your day-to-day life.

So, depending on the stage of kidney failure/treatment you boyfriend is at, you will have different challenges, some physical, more emotional. It can be a heavy load but the big things in life, marriage, children, travel and adventure are still on the cards. Life can still be a joy.

Lastly, I know several young couples living with kidney failure and dialysis. In the main, it has strengthened their relationship and they are living happy, fulfilling lives. However one married couple has parted. The husband was on dialysis and though these things are never clean cut, part of the reason they separated was that his wife found it too difficult. He has since found another partner.

"Aparna has been on dialysis for the past four and half years. She was diagnosed with chronic kidney failure about five years back at the age of 24. Anyone would have been devastated with this sequence of events but not Aparna. She quickly gathered herself and fought to regain control of her life."

"Dr. Suketu Jha is the Chief Nephrologist at Bangalore's Charaka Hospital. Dr. Jha hated for a transplant to fail. A transplant, he believed was the ultimate challenge in nephrology. It was the only real treatment, he felt. Dialysis - even daily - was at best a compromise. Yes, good, frequent, long duration dialysis did offer a good quality of life but it wasn't even close to the quality of life offered by a transplant."

"Prakash took pride in his work. He was extremely confident about his abilities. Education-wise Prakash was like many other dialysis technicians - no graduation degree, only a diploma in Dialysis Technology. Yet, he was very skilled. Patients wanted only him to cannulate. They hardly felt any pain. He could cannulate in one attempt."

These are the main characters from s short story, "In you we trust" that I wrote recently. I will be posting one part of this story every day, starting tomorrow.

I have been thinking of writing a short story for a long time. I have not come across any fiction that has a dialysis unit as the primary setting. I thought it would be very interesting to try my hand at this. If it turns out well, great! If not, well, it will still be ok!

Please let me know how you find it. As always, bouquets and brickbats will both be welcome!